CIO Designation

CIO Designation Application Form

DESIGNATION PROCESS

This application must be completed and submitted to the CIO Association of Canada, Designation Committee for review. This review will involve verification of all submitted information and response regarding CIO Designation obtainment to the applicant will be within 30 days.
Details subject to change.

APPLICANT INFORMATION

Program Start Date
Name
Name
First Name
Last Name
Primary Telephone
Secondary Telephone
Primary Email
Secondary Email

CURRENT EMPLOYER INFORMATION

Employment
Employment
Employer Name
Job Title
Employer Address
City
Province
Postal Code
Industry sector
Type of organization
Please enter the address you would like your certificate mailed to
Please enter the address you would like your certificate mailed to
Address Line 1
Address Line 2
City
State/Province
Zip/Postal
Country
To whom do you report?
What is their title?
Do you have any direct reports?
If yes, how many?
Please describe your current role and the specifics of your 3 years of IT leadership including any past employers and roles

REFERENCES

Please provide the names and contact information of two references that can attest to your 3 years of leadership experience

Reference #1

Name of Reference
Name of Reference
First Name of Reference
Last Name of Reference
Organization
Title
Relationship to applicant
Telephone
Email

Reference #2

Name of Reference
Name of Reference
First Name of Reference
Last Name of Reference
Organization
Title
Relationship to applicant
Telephone
Email

FEES

An active CIOCAN membership is a requirement for maintaining CIO Designation by the CIO Association of Canada.
A full annual CIOCAN membership fee of $750 is required.
Payment is due upon completion of your application review.

DECLARATION

I hereby certify that all statements on the application and in any material filed in support hereof are true, correct and complete, and all material information has been disclosed. I also have read, and agree to comply with the CIO.D Code of Conduct (link here). I understand that the CIO Association of Canada may reject my application for CIO.D Designation based on any of the information in this application found to be inaccurate or misleading. I also pledge to conduct myself in a manner of integrity, honesty and respect for individuals in the CIO Association of Canada community. If I am found to act in a manner contrary to the aforementioned values and in particular the CIO.D Code of Conduct, I understand that I may lose my Designation as a CIO.
Signature (Draw or Type)
Date

Maximum file size: 52.43MB

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